Implementing a clozapine supply service in Australian community pharmacies: barriers and facilitators

Abstract

Background Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, although serious adverse effects such as agranulocytosis and cardiomyopathy limit its use. In July 2015, Australian regulations changed to allow community-based prescribing and supply of clozapine for maintenance therapy. However, there is currently no information on the rate of clozapine services available in Australian community pharmacies, or the factors that influence a pharmacist’s decision to provide, or not provide, a clozapine service, particularly from the perspective of those pharmacists who do not offer this service. This study investigated Australian community pharmacies providing a clozapine supply service and the barriers to, and facilitators of, implementing this service. Methods This mixed method exploratory study was conducted in two stages: (1) a brief online survey of community pharmacists Australia-wide; and (2) semi-structured telephone interviews. The survey was conducted between November 2017–January 2018; results were analysed via descriptive statistics. Survey respondents who did not provide a clozapine service were eligible to participate in a telephone interview exploring barriers and facilitators. Interviews were undertaken between December 2017–January 2018 and data analysed thematically. Results A total of 265 pharmacists completed the survey; 51.3% ( n = 136) provided a clozapine service. Consumer demand was a key facilitator ( n = 18/247; 66.1%) and the main barrier to implementing a clozapine service was a perceived lack of need ( n = 70/122; 57.4%). Twelve survey respondents were interviewed; while most participants acknowledged that supplying clozapine in community pharmacies would benefit consumers due to convenience, the lack of training and support led to difficulties in service implementation. Conclusions Although regulatory changes aimed to improve access to clozapine, it is unclear if they have been successful, or to what degree. Community pharmacists were positive about supplying clozapine in the community but identified a need for training and support to raise awareness of the service so that eligible clozapine consumers can be transitioned to community-based care. Further research is needed about the perceptions of clozapine consumers to determine whether the regulatory changes have resulted in positive outcomes for their independence and quality of life.

What is the extent of research assessing patients’ and clinicians’ perspectives on clozapine treatment? – a comprehensive scoping review

“…Of the total 63 studies reporting on clinician perspectives, 34 reported on perspectives belonging to psychiatrists 86–93 95–97 102 103 106 107 109 113 116 119 122–132 134–137 four on perspectives belonging to non-psychiatrists only 39 94 98 138 and 22 on perspectives belonging to a mixture of different clinicians 25 80 82 84 85 88 99–101 104 105 108 110–112 114 115 117 118 121 133 139 . In four studies 23 81 83 120 , the type of clinicians was unclear (Figure 2, row 1).…”

“…Seventy-three studies reported on perspectives related to active/ongoing clozapine treatment 22–25 29–39 42 43 56–76 78 80–85 89–96 98 100 102–104 108 110 115 117 119 122 126 130 132 133 138 151 159 178 181 (Figure 2, row 2).…”

Antipsychotic prescribing patterns in Australia: a retrospective analysis

“…Examining our study data from 2014 onwards (excluding 2013 as clozapine was not included in this data at that time), there was a small decrease in the proportion of patients prescribed atypical antipsychotic oral medications. There are no clozapine data prior to 2015 in the PBS sample because the treatment was prescribed, and funded by hospitals whose pharmaceutical expenses are funded outside the PBS, under the authority of a hospital-based psychiatrist, with their prescription dispensed from the hospital pharmacy [ 31 ]. There has been an increase in LAT utilisation, however the utilisation of typical LATs has grown more than the utilisation of atypical LATs.…”

Evaluating the Effectiveness of Joint Specialist Case Conferences in Improving Diabetes Control in Patients With Schizophrenia on Clozapine

“…Therefore, if there are adequate management plans on metabolic syndrome/diabetic control ready for patients who may trial clozapine, there are great opportunities to prevent metabolic syndromes, especially diabetes, in those patients. This could possibly increase the usage of clozapine among patients with treatment-resistant schizophrenia, which is currently underutilized (Forrester et al, 2015; Meltzer, 2012; Wilson et al, 2019), and improve patient recovery as a result in future.…”